December 13, 2012

Weekly Language Usage Tips: Medical abbreviations ending in x (Dx, Tx, Hx, etc) & overstate/understate and overestimate/underestimate

Posted in couldn't care less/could care less, medical abbreviations ending in x, overestimate/underestimate, overstate/understate at 6:37 am by dlseltzer

Tip 1: Medical abbreviations ending in x (Dx, Tx, Hx, etc)

A reader writes:

Why do medical abbreviations (e.g., Rx Hx) end in x?  What does the x signify?

This is a great question. When I was first involved with health services research, I was working on a project about organ donation, and in that world, Tx stood for transplantation. I was very confused for a while when I moved to a new project, and Tx suddenly meant treatment or therapy. I have often wondered how this jargon of abbreviations came to be, and why a field focused on science used such imprecise terminology.

Well, I tried to find the answer, but it seems that nobody knows for sure. There is a lot of conjecture. A lot.

It seems that the first abbreviation involving an ‘x’ was Rx which stands for prescription, but how it came to be is much in dispute. Some say that it derives from the Latin, recipere, which mean recipe. Some say it is an invocation to the Roman God, Jupiter, to strengthen the healing process. Some say that it wasn’t originally Rx—it was Px for prescription, but the x was so close to the P, it looked like Rx. Some say it is based on the Eye of Horus, an Egyptian symbol representing health and well-being. No one knows for sure despite what you find in some web chat rooms or on discussion boards where many, many people are quite sure about their own theories. But it really doesn’t matter as the reader was asking about the ‘x’ in abbreviations of some medical terms.

There is Hx which refers to ‘history’ and Dx which stands for diagnosis (in the transplant field, it stands for donation). Sx stands for symptoms and Fx is for family. I’m sure there are others but can’t think of them right now.

The good news is that these abbreviations may show up on medical records, but are never used in medical orders (e.g. prescriptions, plans for care) which are designed to be very precise.

There is some talk on the WWW of why ‘x’ but not very much. My guess is that ‘x’ is just indicating that this is an abbreviation; it’s the variable or unknown.

Remember x marks the spot?

In math, we often have to solve an equation for x.

Then there’s the x factor, and I don’t mean the game show which evidently exists. It’s that unknown or indefinable quality about someone.

And the X Files, and this time I do mean the television show.

It all has to do with something being missing or unknown (except for x marks the spot, but that does, too, in a round about sort of way). I suspect it just connotes that there are letters missing. That’s my guess anyway. And that’s the way I see it.

Tip 2: Understated or overstated

A reader writes:


As in, “the importance of voting to a democratic society cannot be understated.”  WRONG!  As written, this means, I think, that no matter how small the importance of voting is, no words could possibly make it seem any smaller.  The writer should have used “overstated” here, meaning that all the emphatic expressions imaginable about the importance of voting would not be going too far, given how important voting is.  Or am I wrong?

I think the reader is right. I think the writer is trying to say that voting is so important that we can’t say enough about it. But the reader confused ‘understated’ with ‘overstated,’ which is the word he (I’m just assuming the mistake was made by a he) wanted.

‘Understate’ means to represent something as less than it actually is. ‘Overstate’ is just the opposite, and it means to represent something as greater than it is, to exaggerate. The writer really wants to say that he can’t say enough about the importance of voting.

This is actually a fairly common mistake. And understate/overstate is not alone. Underestimate is often misused when overestimate is the intended word.

You cannot underestimate the devastation that Hurricane Sandy brought.

Well, yes, actually you can. You can easily underestimate it by thinking that little destruction occurred. There was quite a bit of destruction—whole communities were lost. It would be more appropriate to say:

You cannot overestimate the devastation that Hurricane Sandy brought.

[NOTE: Instead of brought, I had originally written wrought, but all my dictionaries are telling me that wrought as a verb is archaic. Rats. I know I am old, but archaic? That seems just mean. Really.]

There is a phrase I can think of that suffers from the same type of confusion:

I could care less about the outcome of the Steeler’s game.

What the speaker, here, really means to say is this (assuming the speaker doesn’t care):

I couldn’t care less about the outcome of the Steeler’s game.

This means the speaker doesn’t care at all about whether the Steelers won or not. The first sentence is saying that he does care about the outcome.

[NOTE: Judging by the reactions of the people I saw on Sunday afternoon, the first sentence is really the more accurate one in Pittsburgh.]

But the issue is that ‘could care less’ is frequently used when the speaker (and I say speaker because this construct is rarely written) really means ‘couldn’t care less’ which is the American idiom.

[NOTE: The confusion between the two phrases is so common that some dictionaries consider ‘could care less’ to be an idiom meaning ‘couldn’t care less.’ Yikes!]

Many of the examples I found of these errors—understate or underestimate for overstate or overestimate—are in the political arena. Politicians seem to mistakenly underestimate a lot of things.



  1. Goode article. I recommend this art my friends.

  2. Ne demek said,

    i like this article. Very well written. Since i m interested in medical abbreviations nowadays, this catch me a lot.

  3. Wrought? Your dictionaries struggled with this? Use the British one, you will find that our dictionaries do not class the word as archaic. I am 38, far,far from archaic, and I would have used that term as well. Of course, Yanks tend to think of our language usage as quaint and archaic anyway. 🙂

    • Su said,

      When really, “The Yanks” branched off earlier so in reality THEY are more archaic and have some catching up to do! .I work in pathology and see a lot of Rx, Sx, Hx, Cx (at least cervix has an x to start with) Great Blog, totally agree – in fact couldn’t agree more, (not “could agree more”, so why “could care less”? That’s just lazy and strange)

  4. Oh, and further more, outside of the states, this abbreviation usage is not used, or at least is not used back home. I am having a hell of a time in nursing school dealing with all of these X’s, as well as all of the other abbreviations “you lot” are so fond of.

  5. Anonymous said,

    Fx is more commonly used for “fracture”. Also: Cx- cervical; Tx – thoracic; Lx – lumbar. It seems safe to say that the “x” just stands for the remainder of any word in common usage that clinicians don’t want to write repeatedly. However, many of these are not accepted terminology (e.g. by Medicare in the US). And many facilities have approved terminology that is site specific.

    • Carmen said,

      Another version of fracture (that I’ve been taught) is #, the pound sign. For example, hip #, wrist #, etc.

  6. dancernyc said,

    Thank you for this delightful article. It triggered my first ever blog comment. As a former high school teacher in New York City (for some 30+ years), certain word/phrase choices have affected me like the proverbial fingernails on a chalkboard, even though my subject area was mathematics, not English. I fully understand and accept the dynamic nature of grammar and word usage, but my ears hear as yours, and my brain cries out, “error,” at each “misuse” you describe in your Tip 2 above. As for the medical abbreviations, until this moment I never thought to question their origin, and now add them to my ever growing list of unanswerable questions, next to Heisenberg’s uncertainty principle and Gödel’s incompleteness theorems.

  7. Malissa said,

    Superb blog! Do you have any hints for aspiring writers?
    I’m planning to start my own site soon but I’m a little lost on everything.
    Would you propose starting with a free platform like WordPress or go for a
    paid option? There are so many options out there that I’m totally overwhelmed ..

    Any ideas? Thanks!

    • dlseltzer said,

      I am not an expert on this. I wish you luck.

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